This guide provides instructions for the Client Implementation team to install and configure components necessary to provide a callout to an external claim editing service during adjudication.

Sections of interest are:

• Installation
• System Configuration
• Authentication Credential Configuration
• Troubleshooting

It is important to note that system installation and configuration requires a working knowledge of Visual Studio and compiling DLLs. Claim Editing System Integration implementation requires technical administrative personnel to access and manipulate application configuration files.

Note: Claim Editing System Integration is specific to Context⁴ Healthcare, Inc. (C4H) Context Web Services. The client is responsible for establishing and maintaining an account with the vendor. PLEXIS Claim Editing System Integration will not function within Quantum Choice without valid authentication on an active account assigned by the vendors.

Technical Notes:

• There is a requirement from Context⁴ Healthcare that Provider and/or Practice Office addresses contain a nine digit postal code to pass the Claim Editing System Integration validation, unless this specific rule is disabled (#300799). Disabling/enabling specific claim edit rules is not supported by Quantum Choice. This functionality must be configured directly within the PLEXIS client’s user account in the claim editing system.
• PLEXIS does not store the user name or/password’.  Context⁴ Healthcare requires authentication information to be passed in an unencrypted format.  PLEXIS provides an interface to retrieve the network credentials from the client’s system that are passed to Context ⁴ Healthcare.  The network credential object contains the secure string for the password.
• Externally priced Diagnosis Related Groups (DRG) and Ambulatory Payment Classification (APC) claims are exempt from the Claim Editing System Integration process.